Costovertebral Joints: Difference between revisions

No edit summary
No edit summary
Line 34: Line 34:
The movements on these joints are called ‘pump-handle’ or ‘bucket-handle’ movements, and are limited to a small degree of gliding and rotation of the rib head.  
The movements on these joints are called ‘pump-handle’ or ‘bucket-handle’ movements, and are limited to a small degree of gliding and rotation of the rib head.  
* The function of these movements is to enable lifting of the ribs upwards and outwards during breathing.  
* The function of these movements is to enable lifting of the ribs upwards and outwards during breathing.  
* The end result is the increase of the lateral diameter of the thorax and subsequent expansion of the lung parenchyma as the air is being inhaled<ref>Kenhub [https://www.kenhub.com/en/library/anatomy/costovertebral-joints CV joints] Available from:https://www.kenhub.com/en/library/anatomy/costovertebral-joints (last accessed 10.5.2020)</ref>.
* The end result is the increase of the lateral diameter of the thorax and subsequent expansion of the lung parenchyma as the air is being inhaled<ref name=":0">Kenhub [https://www.kenhub.com/en/library/anatomy/costovertebral-joints CV joints] Available from:https://www.kenhub.com/en/library/anatomy/costovertebral-joints (last accessed 10.5.2020)</ref>.
'''The costovertebral complex is an essential component of the biomechanics of chest wall movement.'''  
'''The costovertebral complex is an essential component of the biomechanics of chest wall movement.'''  


Line 51: Line 51:
[[sternocleidomastoid]], [[scalene]], [[Serratus Anterior|serratus anterior]], [[pectoralis major]], [[Pectoralis Minor|pectoralis minor]], [[Latissimus Dorsi Muscle|latissimus dorsi]] and [[serratus posterior]] superior.
[[sternocleidomastoid]], [[scalene]], [[Serratus Anterior|serratus anterior]], [[pectoralis major]], [[Pectoralis Minor|pectoralis minor]], [[Latissimus Dorsi Muscle|latissimus dorsi]] and [[serratus posterior]] superior.


===Innervation of the costovertebral ligaments<ref name=":0">Muacevic. A & Adler.J ,2016,Ligaments of the Costovertebral Joints including Biomechanics, Innervations, and Clinical Applications: A Comprehensive Review with Application to Approaches to the Thoracic Spine,PMC5154401, V.8(11)
===Innervation of the costovertebral ligaments ===
</ref> ===
Both types of costovertebral joints are innervated by the lateral branches of the posterior rami of spinal nerves C8-T11.  
Innervation of the costovertebral ligaments is supplied by the '''lateral branch of the thoracic dorsal rami of C8 and T1 to T11''' . The costovertebral joints receive this innervation in a segmental fashion with each joint receiving fibers from the level above and directly below it. Pain originating from the joints is well-localized and level specific . This seems to follow Hilton’s law, which states “that the innervation of a joint is the same innervation as the muscles which move the joint and the skin overlying the joint” .
* The innervation has a segmental pattern
 
* Each joint receives the fibers from a spinal nerve of its numerically equivalent level and from the level above.<ref name=":0" />
Mechanoreceptors have been identified in the region of the middle costotransverse ligament . This innervation is characteristic of neurons providing nociception and mechanoreceptor activity. Activation of these mechanoreceptors, either by mechanic loading or inflammation, may cause pain and reflex muscular hypertonus. Tachykinins (substance P and calcitonin gene-related peptide), neuropeptides activated in response to nociceptive stimulation, have been found aside costovertebral ligaments. Thus, it appears that known neuropeptides are present along the costovertebral ligaments that can activate pain and propagate an inflammatory cascade .
 
Studies in rabbits have identified slowly adapting mechanoreceptors in the costovertebral complex that are capable of signaling the absolute rib position, direction and velocity of movement . These mechanoreceptors are also sensitive to tension and can alter the strain of the surrounding ligaments. There is a group of these receptors that is sensitive to caudal rib movement, known as “expiratory receptors,” and a group that is sensitive to rostral rib movement, or “inspiratory receptors” . There have been no similar studies in humans. Nonetheless, these findings provide a probable pathway to consider. In approximately 60% of individuals, there is a linkage of the brachial plexus to the first and/or second intercostal nerve, known as Kuntz’s nerve. Therefore, disorders affecting the first or second costovertebral joints can result in arm pain referred via this pathway .


==References==
==References==

Revision as of 07:42, 10 May 2020

Original Editor - Rewan Aloush


Top Contributors - Rewan Aloush, Lucinda hampton, Kim Jackson and George Prudden  

Introduction[edit | edit source]

The costovertebral joints describe two groups of synovial plane joints which connect the proximal end of the ribs with their corresponding thoracic vertebrae, enclosing the thoracic cage from the posterior side.

Costovertebral articulations. Anterior view.

Joining of ribs to the vertebrae occurs at two places

  1. Head - Two convex facets from the head attach to two adjacent vertebrae. This forms a synovial planar (gliding) joint, which is strengthened by the ligament of the head and the intercapital ligament.
  2. Tubercle of the rib - Articulation of the tubercle is to the transverse process of the adjacent vertebrae. This articulation is reinforced by the dorsal costotransverse ligament[1]

Anatomy[edit | edit source]

  1. Costovertebral joint consists of the head of the rib articulating with:

The head of a typical rib has two facets (each facet with a separate synovial joint) separated by a ridge:

  • Lower rib facet articulates with the upper costal facet of its own vertebra
  • Upper facet articulates with the lower facet of the vertebral body above. 
  • The first rib articulates with the T1 vertebra only and the lowest three ribs articulate only with their own vertebral body.

There are two types of ligaments:

  1. intra-articular ligament - attaches the intervertebral disc to the ridge in between the two facets of the head of the rib.
  2. radiate ligament - formed by three bands which connect the rib head to the vertebral bodies. A superior band runs to the vertebral body above and an inferior band runs to the vertebral body below. A central band runs deep to the anterior longitudinal ligament and blends into the intervertebral disc to join the ligament on the opposite side. In the first rib and the last three ribs, only two bands exist as they only articulate with their own vertebra[2].

2. Costotransverse Joint

There are two facets of a tubercle of a rib, the medial and lateral.

  1. The hyaline cartilage-lined medial facet forms a plane synovial joint with the tip of the transverse process which is reinforced by a capsule.
  2. The lateral facet is attached to the transverse process through three ligaments:
  • lateral costotransverse ligament - attaches the lateral facet to the tip of the transverse process of the vertebral body.
  • costotransverse ligament - attaches the back of the neck of the rib to the front of the transverse process
  • superior costotransverse ligaments - attaches the neck of the rib to the underside of the transverse process of the vertebra above

The lower two ribs are only attached by ligaments and do not form synovial joints with the transverse process[2].

Movements[edit | edit source]

The movements on these joints are called ‘pump-handle’ or ‘bucket-handle’ movements, and are limited to a small degree of gliding and rotation of the rib head.

  • The function of these movements is to enable lifting of the ribs upwards and outwards during breathing.
  • The end result is the increase of the lateral diameter of the thorax and subsequent expansion of the lung parenchyma as the air is being inhaled[3].

The costovertebral complex is an essential component of the biomechanics of chest wall movement.

The costovertebral ligaments make the actions of the costovertebral joints and intervertebral movement possible.

The ligaments function to

  • Affix, stabilize and allow some motion of the ribs on the thoracic vertebra at the costovertebral joint. Their presence helps with the load-bearing, protection, posture and scaffolding roles that the thoracic cage provides with their stabilization properties .
  • Allow and limit movement of the ribs at the transverse joint to allow for maximum expansion of the thoracic cavity as needed for respiratory demand. Their actions on both the costovertebral and intervertebral complexes allow lateral bending and axial rotation.

Muscles that act on the costovertebral joints[edit | edit source]

The prime movers of the costovertebral joints are the muscles of respiration.ie

However, all the muscles that attach to the ribs and which are sorted as accessory respiratory muscles can cause the movements on these joints;

sternocleidomastoid, scalene, serratus anterior, pectoralis major, pectoralis minor, latissimus dorsi and serratus posterior superior.

Innervation of the costovertebral ligaments[edit | edit source]

Both types of costovertebral joints are innervated by the lateral branches of the posterior rami of spinal nerves C8-T11.

  • The innervation has a segmental pattern
  • Each joint receives the fibers from a spinal nerve of its numerically equivalent level and from the level above.[3]

References[edit | edit source]

  1. ↑ Gray.H,Gray's anatomy 20th edition,page 299
  2. ↑ 2.0 2.1 Radiopedia Costrovert. Joint Available from:https://radiopaedia.org/articles/costovertebral-joint (last accessed 10.5.2020)
  3. ↑ 3.0 3.1 Kenhub CV joints Available from:https://www.kenhub.com/en/library/anatomy/costovertebral-joints (last accessed 10.5.2020)
Retrieved from "https://www.physio-pedia.com/index.php?title=Costovertebral_Joints&oldid=237304"